Writing the Roller-coaster: Managing Stress and Uncertainty

TEEN GROUP THERAPY Registration Form

Participant Information

Experiencing the COVID blues? Feeling anxious, worried, stressed? Up one minute – down the next?

Ambiguity is a bit like riding a roller coaster. Some will love it and others won't want to go near it. Some rides are choppy and nerve-wrecking and other rides are a thrill. Unfortunately, like it or not, we're all on the wild, turbulent ride not knowing when the next twist or turn will come. This online therapeutic writing group is a creative way to explore and reflect on our current life situation. It is a way to feel stronger and better able to manage the challenges that have been thrown in our path.

For Teens

Thursdays, May 14th to June 18 (6 wks) online

3:00 pm to 4:00 pm

$35/session or $180 for series if paid at 1st session

May be covered by insurance or use HSA or FSA

*If a new client, an individual intake session is needed. This could be billed under your individual mental health benefits. Needs to be scheduled PRIOR to the first group session

Participant Name
*

First Name Last Name

Gender
*

Age
*

Date of Birth
*

Month Day Year

Address
*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Email
*

example@example.com

Phone Number (cell)
*

-
Area Code Phone Number

For doing the Group Telehealth session, where do you want your invite sent?
*

EMAIL listed above PHONE # listed above

Consent to Telehealth Information

CONSENT FOR TELEHEALTH THERAPY |It is my expectation that you will benefit from online therapy as all or part of your psychotherapy, but there is no guarantee. Therapy is conducted using interactive audio and video. Online based services as care may not be appropriate for your need. If I assess that face to face is more appropriate, I will offer an appointment or provide referrals.

Signature & Payment

By signing and submitting this registraiton form, you understand and agree to all policies.

Once you click "Register" you will be redirected to pay the registration fee. You may use your credit/debit card to pay the fee.

If you have chosen "Insurance Verified Coverage (by Alliance for Healing)" without verifying your please contact our business office 651-493-8150 and ask for Karen or admin@aheartt.com for verification code to complete your registration.